Educate patients on dialysis regarding the signs and symptoms of hyperkalaemia, so that they can seek medical attention promptly if required.
Patients with chronic hyperkalaemia and risk factors for hyperkalaemia should be aware of the risk of hyperkalaemia and its life-threatening consequences. See Risk factors.
Provide patients with chronic hyperkalaemia and those at risk of hyperkalaemia with information regarding dietary sources of potassium, and methods of reducing potassium intake via diet.
Advise patients with end-stage kidney disease on dialysis that a low-potassium diet and compliance with dialysis are key in preventing hyperkalaemia.[13]Chan KE, Thadhani RI, Maddux FW. Adherence barriers to chronic dialysis in the United States. J Am Soc Nephrol. 2014 Nov;25(11):2642-8.
https://www.doi.org/10.1681/ASN.2013111160
http://www.ncbi.nlm.nih.gov/pubmed/24762400?tool=bestpractice.com
[14]Allon M, Takeshian A, Shanklin N. Effect of insulin-plus-glucose infusion with or without epinephrine on fasting hyperkalemia. Kidney Int. 1993 Jan;43(1):212-7.
https://www.doi.org/10.1038/ki.1993.34
http://www.ncbi.nlm.nih.gov/pubmed/8433561?tool=bestpractice.com
[15]Allon M. Hyperkalemia in end-stage renal disease: mechanisms and management. J Am Soc Nephrol. 1995 Oct;6(4):1134-42.
https://www.doi.org/10.1681/ASN.V641134
http://www.ncbi.nlm.nih.gov/pubmed/8589279?tool=bestpractice.com
Also advise these patients to avoid periods of fasting, as this can lead to increased potassium movement out of the cells due to decreased insulin secretion and also causes resistance to beta-adrenergic stimulation of potassium uptake.[14]Allon M, Takeshian A, Shanklin N. Effect of insulin-plus-glucose infusion with or without epinephrine on fasting hyperkalemia. Kidney Int. 1993 Jan;43(1):212-7.
https://www.doi.org/10.1038/ki.1993.34
http://www.ncbi.nlm.nih.gov/pubmed/8433561?tool=bestpractice.com
[15]Allon M. Hyperkalemia in end-stage renal disease: mechanisms and management. J Am Soc Nephrol. 1995 Oct;6(4):1134-42.
https://www.doi.org/10.1681/ASN.V641134
http://www.ncbi.nlm.nih.gov/pubmed/8589279?tool=bestpractice.com
Note that this can also occur in patients without diabetes.[14]Allon M, Takeshian A, Shanklin N. Effect of insulin-plus-glucose infusion with or without epinephrine on fasting hyperkalemia. Kidney Int. 1993 Jan;43(1):212-7.
https://www.doi.org/10.1038/ki.1993.34
http://www.ncbi.nlm.nih.gov/pubmed/8433561?tool=bestpractice.com